Service specification for Oesophago-gastric (OG) cancer

Transcription

1 London Cancer: Service specification for Oesophago-gastric (OG) cancer April 2013 Version 2.1 OG Service Specification V2.1.docx

2 1. Introduction 1.1. London Cancer The cancer care providers of North East London and North Central London and West Essex agreed in July 2011 to develop an integrated cancer system in response to the requirements of London s Strategic Health Authority and commissioners through the Model of Care for Cancer in London. Since April 2012 this integrated cancer system, London Cancer, has been commissioned to provide cancer services for a resident population of 3.2 million. Its mission is to drive superior outcomes and experience for our patients and local communities, and thereby position its staff as leaders in cancer care locally, nationally and globally. London Cancer will be underpinned by patient-empowerment, research, evidence and information sharing. It will radically refocus hospitals into working in partnership with each other, primary care and patients, to deliver coordinated, comprehensive pathways of excellent care for every patient irrespective of where they access our system or the type of cancer that they have. The agreed priorities of the integrated cancer system are: Being patient-focused through listening, communication, involvement, information, education, choice, and personalisation Optimising care along a co-ordinated pathway earlier diagnosis, exceptional treatment for all, local treatment where appropriate, compassionate aftercare and empowering/supporting patient selfmanagement Embedding research for personalised care, equitable access to trials, the discovery of new treatments and evaluating new ways of working together with patients Increasing value superior outcomes for patients per pound invested. In addition to these priorities, London Cancer has carried out extensive research on what matters to patients and has distilled this work into ten key themes that will be central to everything that we do: 1. Diagnosis patients are diagnosed at an earlier stage 2. Ethos patients are treated holistically as individuals, and with dignity, sensitivity and respect, so that they do not feel that they are treated as a set of cancer symptoms 3. Communication patients receive written and verbal information about diagnosis and all treatment options, including side effects and quality of life implications 4. Choice patients and carers are fully involved in the choice of hospital and treatment options 5. Support patients are given information on support groups, benefits entitlement and are offered emotional and psychosocial support 6. Carers carers are fully involved and supported throughout the pathway 7. Holistic assessment patients have holistic assessments at appropriate stages throughout the pathway, with action to meet their needs taken as a result 8. Seamless care all patients are assigned a CNS when diagnosed and a community key worker on discharge 9. Transport patients should only travel when necessary and appropriate arrangements should be made for the immunosuppressed; patients should be provided with free parking or transport vouchers 10. Discharge patients and their GPs should be provided with discharge information and follow-up advice. 2

3 1.2 Oesophago-gastric pathway board The Oesphago-gastric Cancer Pathway Board has agreed and published its work programme to achieve better outcomes for patients with oesophageal and gastric cancer in the geographical area covered by the London Cancer integrated Cancer system. The board has identified the following areas as priority: Early diagnosis patients who present late with symptoms for OG cancer tend to suffer poorer outcomes Improving patient pathways for diagnostics and staging given the complexity of OG cancer, patients are often seen at over 6 different sites before definitive treatment commences Improving dietetics support due to the nature of some types of surgery, patients often suffer from problems associated with diet. Patient representative, AHPs and CNS are working on developing a tool for prompt dietetic discussion. In addition, the group hopes to improve access to one to one consultation with a dietitian from diagnosis to discharge and beyond Working towards a model of care looking at service reconfiguration across the patch to provide the best possible care for the needs of our population Developing a research programme in the management of OG cancer 1.3 Service specification process London Cancer will deliver a step-change in cancer services in North East London and North Central London and West Essex. To instigate change, several pathway boards have constituted a technical group, which is responsible for developing a specification for future delivery of services along their pathways within the integrated cancer system. The organisations of London Cancer that contribute to the pathway will then be invited to demonstrate how they could meet the requirements of these specifications for the components of the pathway that they wish to provide. In OG cancer, a pre-meet of surgeons took place in December 2012 to discuss the proposal for a specification, and each Trust and specialty was invited to participate in the technical sub group. The London Cancer OG technical group met on several occasions from January March The result is found in the following pages. A full list of those who sat on the group can be found in the appendix. 1.4 Service specification brief The OG technical sub group was tasked with developing a service specification to implement the recommendations of the London Model of Care for Cancer. The group was asked to consider the optimal care pathway for a patient with OG cancer across the London Cancer jurisdiction. In doing so, the group was advised to consider every element of the patient journey from initial diagnosis right through to end of life care or survivorship. As the technical group could not reach consensus on the optimum number of specialist surgical sites, the London Cancer Board decided to obtain independent clinical expert advice on the optimal number of sites we should be aiming for to serve the population of the ICS for specialist surgery in OG cancer. This allowed members of the technical group to complete writing the service specification, and to focus on the principal elements of a quality service for a specialist centre and local diagnostic, treatment and follow up services whilst this external advice was obtained. This expert external advice concluded that the optimal configuration of specialist surgical sites for the most rapid trajectory to achieve world class outcomes for our 3

4 patients, would be to have a single centre on one site, but that a single service across two sites could be acceptable according to the populations served. Any OG surgical centre should meet the NHS England commissioning specification and be Peer Review compliant. 1.5 Background - specialist surgery The Model of Care for cancer services makes a case for reconfiguring the management of rarer cancers (which includes OG cancer) along the following lines: 1. The centralisation of specialist services has benefits for both patients and services themselves 2. Some of London s rarer cancer services should be further centralised 3. Some of London s rarer cancer services are appropriately configured, but improvements to these services are still possible 4. Specific arrangements should be made for providing highly specialist services associated with rarer cancers. The key recommendation for OG cancer is: Four providers for oesophago-gastric cancer surgery should be commissioned in London, each serving a catchment population of at least 2 million. NHS England has also recently published a draft service specification, which it has consulted on. It defines three levels of care to manage OG cancer the diagnostic process, local care and specialist care. NHS England will expect all Trusts to comply with this as a minimum specification. AUGIS recommends: Specialist surgeons each performing resections a year 24 hours, 7 day a week cover The figures below show the number of oesophagectomies and gastrectomies carried out with the 3 Trusts in London cancer over a period of 12 months from January 2012 to December Current surgical activity figures for OG cancer centres CENTRE OESOPHAGECTOMY GASTRECTOMY LOCAL EXCISION or PALLIATIVE OPERATIONS Barts Health TOTAL NUMBER OF PROCEDURES UCLH BHRUT DAY MORTALITY The following service specification will denote what an optimal local OG cancer unit would look like, followed by a recommendation of the optimal OG cancer surgical centre. Proposed number of surgical centres In the U.K there are now several centres that have re-configured to surgical centres that are operating on over 120 patients a year with patients travelling much further for the complex surgical element of care. Detailed publications reporting the improvement in services from such centres are awaited, but many have 4

5 reported reductions in mortality of surgery and good patient experience as measured by the National Cancer Patient Experience Survey. London Cancer recognises the uncertainties about the referral population to be served by our service, given the developing UCLPartners Academic Health Science Network and changes to strategic clinical networks. Hence, the pathway board has been directed to move forward with a specification that asks specialist providers to define their referral base and population and to show how they will comply with a minimum standard of a 1 in 4 dedicated rota of specialist surgeons each doing at least major resections per year, given the recommendation that such a service serves a population of 2 million. If providers are able to demonstrate sufficient population and referral base, as well as clearly evidenced commitments to provide the required level of specialist surgical support, the outcome of the application process may see a recommendation to designate more than one OG surgical centre in London Cancer for the immediate future. We would expect them to work as a single service using common protocols, research and audit, as well as training programmes and to set an aspirational direction of travel about consolidating onto one site in the future. As such, we would welcome joint or collaborative applications in response to the service specification. 5

6 2. OG cancer specification : Local OG Cancer Unit POINT IN THE PATHWAY Primary care Diagnosis 2ww referral 1 stop service Endoscopy Inpatient/emergency or cross specialty referral LOCAL OG CANCER UNIT SPECIFICATION Rapid response mechanism for primary care advice for GPs flagged up via the 2ww office Hold specialist Upper GI population and public awareness events twice per annum GPs use NICE 2-week GI referral criteria and London Cancer agreed forms and criteria 2ww proforma to be fully completed with all basic information and sent over nhs.net account GPs to use NICE dyspepsia guidance Open access endoscopy available to all GPs within 4 weeks Provide GPs with a list of contact details for all OG teams in each cancer unit Patients presenting to GPs with known Barrett s Oesophagus who are not know to the local provider unit should be considered for referral for Barrett s surveillance Participate in pilots for screening (e.g. cytosponge) Manage all patients at a one stop service All patients seen within 2 weeks for assessment after 2ww referral in a one stop service Consultant-led clinic, with cover for leave and absence Carry out ECG and blood tests Patient advised at endoscopy if there is suspicion of cancer by qualified member of staff with advanced communication skills training, usually a CNS. If no CNS available, contact details should be given. All patients should receive nutritional screening using a validated nutritional screening tool Patients with >10% unintentional weight loss over last 6 months (or drop in clothes by 2 sizes) to be identified to dietitian OG trained specialist endoscopist (preferably JAG accredited) with dedicated Upper GI list Results given to patient promptly If cancer is suspected, urgent CT scan to be requested. Patient to leave endoscopy with a requested CT appointment Results faxed to GP within 24 hours CT to take place within 1 week Endoscopist to inform patient on the day if findings suspicious of cancer, with support from a CNS Patient given a copy of the endoscopy report to take away with them if appropriate Direct referral to endoscopy/opinion within 1 week from any specialty for suspicion of OG cancer Patient discussed at the next available MDT OG Service Specification V2.1.docx

7 LOCAL OG CANCER UNIT SPECIFICATION Local Multidisciplinary Team (MDT) Composition Clinical Nurse Specialist Senior specialist dietitian Treatment recommendation Information CNS Surgeon (please note this is above peer review requirements) Oncologist Gastroenterologist Palliative care representative MDT Coordinator Radiologist Histopathologist Senior specialist dietitian Skilled team member with level 2 training in psychology and access to clinical psychology to be available if required Access provided to a named CNS for all patients CNS able to present patients at MDT meeting Clear identification of key worker at each stage Efficient liaison between local and specialist CNS Adequate provision of CNS staff for every patient, covering annual leave and sickness absence Access provided to a senior specialist dietitian for all patients with identified nutritional needs Core member of the MDT Functioning at a minimum of level 3 Responsible for detailed assessment of nutritional requirements and for promoting discussion of methods to support nutritional intake (e.g. placement of artificial feeding tube) Arrangements in place for experienced dietetic cover for annual leave and sickness absence to maintain patient access to service Treatment recommendation informed by patient comorbidities, fitness and functional status Staff presenting the patient need to come prepared with full information on their patients Capacity for reliable videoconferencing with the Cancer centre Availability of videoconferencing at an appropriate time for local MDT linking in to specialist MDT Complete Minimum Data Set (MDS) prior to discussion in the local and with specialist MDT Documentation of tumour staging at first MDT meeting Responsible clinician to inform GP within 24 hours of decision to treat Smooth and accessible transfer of imaging between Trusts Capacity for real-time electronic recording of discussions and decisions Reason for non-curative therapy to be recorded 7

8 Holistic care Communication Giving results First decision to treat Timeliness of treatment Pre-treatment assessment LOCAL OG CANCER UNIT SPECIFICATION Completion of London Cancer MDT proforma to inform MDT discussion Capacity to record nutritional status Ensure holistic needs assessments are available for every patient Refer to appropriate cancer rehabilitation specialists i.e. dietitian, physiotherapy, occupational therapist or speech and language therapist Clinical workforce have undertaken Advanced Communication Skills Training Offer the patient the option to bring someone CNS to call the patient and arrange a time suitable for them to attend an appointment Explain the findings to the patient in as much detail as is appropriate for each individual patient Inform patient of their diagnosis and next steps CNS to be present when significant results are given Discussion of all appropriate treatment options with patient CNS available at every appointment Consultant to offer patients a copy of the GP letter and/or a written account of their diagnosis Consultant to write to the GP and patient with treatment options Provide support to patient and family as required Offer participation in clinical trials if appropriate Collect samples if patient consented to clinical trials Give patients information on all charities and extra support relating to OG cancer Ensure patient is informed of the next steps and who the care will be handed over to if patient is referred to a specialist centre Capacity to assess and treat patients with minimum delay and at least within 62 days of urgent referral and 31 days of diagnosis Referral to a specialist centre within 3 weeks of the patient pathway to allow adequate time for further treatment Prior to the start of treatment patients to be assessed by a team that includes (as a minimum) the CNS and dietitian, with capacity for additional therapy input depending on functional status and co-morbidities. Location of pre-treatment assessment may vary between local and specialist centres appropriate, but both MDTs to share responsibility for ensuring that it takes place and that the information gathered is available to both. Patients to be given practical information to plan how they 8

9 LOCAL OG CANCER UNIT SPECIFICATION will approach the challenges of treatment Relatives/carers involved with preparing meals should be given written information specific to them and including the contact number of the dietitian Where tube feeding is required prior to the start of treatment its insertion should not cause pathway delay. Specialist Clinical Oncology: Radiotherapy (where provided locally) Specialist Medical and Clinical Oncology: Chemotherapy (where provided locally) Palliative endoscopy Radiotherapy offered to all appropriate patients Treats patients in a timely manner Oncologists with some sessions devoted to OG oncology Access to a Specialist Dietician with expertise in dealing with Upper GI Take full part in all relevant clinical trials Neoadjuvant chemotherapy to be offered to all OG cancer patients who meet the criteria Adjuvant chemotherapy or chemo-radiotherapy to be offered if appropriate Clear referral pathway with chemotherapy units Senior Specialist Upper GI dietitian available to see all nutritionally at risk patients. All local cancer units, or units within easy travelling distance of the local hospital, to offer patients a full range of palliative endoscopy options including: Stenting Laser therapy Post-treatment Discharge Discharge to be carried out by skilled specialist professionals Follow-up Provide electronic end of treatment summaries with accessible record of treatment to GPs and patients Process in place for rapid access to advice or re-admission if necessary Dietitian to handover to treatment centre according to planned pathway or follow up palliative patients locally according to patient choice Carer information and support to be provided from CNS and AHPs i.e. Dietitian, SLT, Physiotherapist and Occupational therapy. Advise GP of the outcome of the patients treatment Rehabilitation Primary care Adhere to nationally-agreed NCAT rehabilitation care pathway Ensure standardised handover between treatment settings and treatment modalities by secure within one week of final assessment Send discharge summary to the GP and give a copy to the patient 9

10 LOCAL OG CANCER UNIT SPECIFICATION Metastatic disease Palliative care Clear referral pathways for patients with palliative and specialist palliative care needs Clear referral guidance for management of: End of Life care Complex symptom control GP and palliative care team including AHPs to manage patient as appropriate Patients provided with information on local hospices and charity groups Acute oncology Acute presentation at A&E Research and innovation Education and training Patient travel Full acute oncology service with clear guidelines such as neutropaenic sepsis and metastatic spinal cord compression Use a flag warning system to identify patients who have had chemotherapy or radiotherapy within the last 6 weeks Contact details of all OG cancer unit staff to be available in each emergency department Specialist Palliative Care Teams to be linked together Use a flag warning system to identify any cancer patients when they present Alert the appropriate oncology team for any cancer patients admitted via A&E Carry out prospective audit of service and publish transparent outcomes data Participation in London Cancer audit programme and National Audits Training for specialist CNS staff in specialist Upper GI cancer work Training for dieticians to become level 3 and 4 specialists Training courses for all professional members in specialist Upper GI Inform patients of support available for travel to cancer centre Assists patient in benefits application for travel costs Revise criteria for patient transport so it can be offered to a greater selection of patients who need it Adequate provision for patient transport and clear support strategies for patients relatives 10

11 3. OG cancer specification : Specialist OG Cancer centre POINT IN THE PATHWAY Primary care Diagnosis 2ww referral 1 stop service Endoscopy OG CANCER CENTRE SPECIFICATION Rapid response mechanism for primary care advice flagged up via the 2ww office Hold specialist Upper GI population and public awareness events twice per annum GPs to use NICE 2-week GI referral criteria and London Cancer agreed forms and criteria 2ww proforma to be fully completed with all basic information and sent over nhs.net account GPs to use NICE dyspepsia guidance Open access endoscopy referral available to all GPs within 4 weeks Provide GPs with a list of contact details for all OG teams in each cancer unit and cancer centre for rapid access Patients presenting to GPs with known Barrett s Oesophagus who are not know to the local provider unit should be considered for referral for Barrett s surveillance Participate in pilots for screening Two- week wait referrals to be treated in a one stop service clinic seen within 2 weeks Consultant-led clinic, with cover for leave and absence Manage all patients in a one stop service Carry out ECG and blood tests Patients to have an endoscopy within 1 week of last appointment if required Patient advised at endoscopy if there is suspicion of cancer by qualified member of staff with advanced communication skills training, usually a CNS. If no CNS available, contact details should be given. Nutritional assessment to be carried out using a validated screening tool Patients with >10% unintentional weight loss over last 6 months (or drop in clothes by 2 sizes) to be identified to dietitian OG trained, JAG accredited endoscopists, Endoscopists skilled in EUS, EMR and ESD Results given to patient promptly If cancer is suspected, urgent CT scan requested. Patient to leave endoscopy with a requested CT appointment Results faxed to GP within 24 hours CT to take place within 1 week Endoscopist to inform patient on the day if suspicious of cancer with support from a CNS Patient given a copy of the endoscopy report to take away if appropriate 11

12 Pathology Radiology Inpatient/emergency or cross specialty referral OG CANCER CENTRE SPECIFICATION Adequate number of specialist Pathologists to support the service Specialist UGI Radiologists for diagnosis and staging Specialist Radiologists with interventional skills Full range of imaging modalities including PET, CT and MRI Direct referral to endoscopy/opinion within 1 week from any specialty for suspicion of OG cancer Patient discussed at the next available MDT meeting Process for management of patients between MDT meetings Multidisciplinary team(mdt) Workload Composition Clinical Nurse Specialist Dietitian Treatment recommendation Information Minimum population of 2 million CNS Surgeons Oncologist clinical and medical Gastroenterologist MDT coordinator Interventional Radiologist EUS and EMR specialities represented Histopathologist/Cytopathologist Palliative care Physician/Practitioner Senior specialist dietitian Access provided to a named CNS for all patients CNS able to present patients at MDT Clear identification of key worker at each stage Efficient liaison between local and specialist CNS Adequate provision of CNS staff for every patient covering annual leave and sickness absence Access provided to a senior specialist dietitian for all patients with identified nutritional needs Core member of the MDT Functioning at a minimum of level 4 Responsible for detailed assessment of nutritional requirements and for promoting discussion of methods to support nutritional intake (e.g. placement of artificial feeding tube) Arrangements to ensure experienced dietetic cover for annual leave and sickness absence to maintain patient access to service Treatment recommendation informed by patient comorbidities, fitness and functional status Staff presenting the patient need to come prepared with full information on their patients Capacity for reliable videoconferencing Availability of videoconferencing at an appropriate time for 12

13 Holistic care Communication Giving results First decision to treat Timeliness of treatment OG CANCER CENTRE SPECIFICATION local MDT to link in to specialist MDT meeting Completion of Minimum Data Set (MDS) prior to discussion with the specialist MDT Documentation of tumour staging at first MDT meeting Responsible clinician to inform GP within 24 hours of decision to treat Smooth and accessible transfer of imaging between Trusts Capacity for real-time electronic recording of discussions and decisions Reason for non-curative therapy to be recorded Completion of London Cancer MDT proforma to inform MDT discussions Capacity to record nutritional status Ensure holistic needs assessments are available for every patient Refer to appropriate cancer rehabilitation specialists i.e. dietitian, physiotherapy, occupational therapist or speech and language therapist Clinical workforce have undertaken Advanced Communication Skills Training Offer the patient the option to bring someone along CNS to call the patient and arrange a time suitable for them to attend an appointment Explain the findings to the patient in as much detail as appropriate for each individual patient Inform patient of diagnosis and next steps CNS to be present when significant results are given Discussion of all appropriate treatment options with patient CNS to be available at every appointment Consultant to offer patients a copy of the GP letter and/or a written account of their diagnosis Consultant to write to the GP and patient with treatment options Provision of support to patient and family as required Offer participation in clinical trials if appropriate Collect samples if patient consented to clinical trials Provide patients with information on all charities and extra support relating to OG cancer Ensure patient is informed of the next steps and who the care will be handed over to if patient is referred to a specialist centre Capacity to assess and treat patients with minimum delay and at least within 62 days of urgent referral and 31 days of diagnosis Referral to a specialist centre within 3 weeks of the patient 13

14 OG CANCER CENTRE SPECIFICATION pathway to allow adequate time for further treatment Pre-treatment assessment Prior to the start of treatment patients to be assessed by a team that includes (as a minimum) the CNS, dietitian and physiotherapist (with capacity for additional therapy input depending on functional status and co-morbidities). Patients should be given practical information to plan how they will approach the challenges of treatment. Relatives/carers involved with preparing meals should be given written information specific to them and including the contact number of the dietitian. Where tube feeding is required this should follow agreed criteria including patient information that is consistent across the pathway Surgery and endoscopic treatment Surgical volumes Two centres with each centre carrying out a minimum of 60 oesophago-gastric resections per year Treatment Inpatient care Both surgical centres working as a SINGLE team working to the same protocols and guidelines Each surgeon to undertake at least resections per year Minimum of 4 surgeons to provide 24/7 on call rota for postoperative cases at the cancer centre site Counselling for patients offered pre-surgery Hub and spoke surgeons to work together as a team Surgeons to operate in pairs where appropriate Provide the full spectrum of OG cancer procedures: Gastrectomy Oesophagectomy Expertise & infrastructure for complex procedures e.g. salvage oesophagectomy following chemoradiotherapy and oesophageal reconstruction Minimally invasive surgical techniques Endoscopic therapies including resection of early tumours Benign work likely that some complex benign work will need to come to the centre i.e. oesophageal perforations, and complex benign oesophagogastric conditions Stenting Pre-operative work-up to include comprehensive assessment and pre-optimisation with the involvement of specialist dietitians, physiotherapists, CNS and anaesthetists Patients always accommodated on single sex wards Enhanced Recovery after Surgery (ERAS) programme to be offered to all suitable patients Staff on wards to have training in treating OG patients particularly in relation to diet and physiotherapy Upper GI Specialist Dietitian to review patient at least 3 times 14

15 Skills and workforce OG CANCER CENTRE SPECIFICATION during inpatient stay. On planning for discharge ensure appropriate information for patient and carer and involvement of local services where required. Specialist anaesthetists trained in thoracic anaesthesia Surgical outreach from the centre for post op follow up Access to oncology including clinical trials, neo adjuvant, adjuvant and palliative treatment Endoscopic diagnostics from a gastroenterology team who can manage 2WW and direct access referrals Skills for endoscopic palliation Information Regularly audit service and outcomes and publish results Interdependencies There are no interdependencies for OG surgery Specialist Clinical Oncology: Radiotherapy Specialist Medical and Clinical Oncology: Chemotherapy Palliative endoscopy Treatment Treatment Radiotherapy offered to all appropriate patients Treats patients in a timely manner Oncologists with some sessions devoted to OG oncology Access to a Specialist Dietitian with expertise in dealing with Upper GI Take full part in all relevant clinical trials Neoadjuvant chemotherapy to be offered to all OG cancer patients who meet the criteria Adjuvant chemotherapy or chemoradiotherapy to be offered if appropriate Clear referral pathway with chemotherapy units Senior Specialist Upper GI Dietitian available to see all nutritionally at risk patients. Patients offered a full range of palliative endoscopy options: Stenting Laser therapy Oncology nutrition management All patients to be screened using validated nutritional screening tool (or handover from diagnostic or surgical setting) Pre-treatment assessment by CNS and dietitian for all patients as appropriate Initiation of artificial tube feeding to be achieved without delaying start of treatment For radiotherapy, dietetic review to be provided weekly For chemotherapy, dietetic review according to weight chart 15

16 OG CANCER CENTRE SPECIFICATION Post treatment Discharge Discharge to be carried out by skilled specialist professionals Follow up Provide electronic end of treatment summaries with accessible record of treatment to GPs and patients Processes to ensure rapid re-admission if necessary Carer information and support to be provided from CNS and AHPs Dietetic follow up for at least one year following surgery and/or chemoradiation by at least level 3 staff Joint CNS and dietetic follow up to be available for patients following palliative treatment according to patient choice Carry out follow up according to published guidelines Follow up to be carried out locally by members of the specialist MDT (surgeons or CNS, as appropriate) Rehabilitation Adherence to nationally-agreed NCAT rehabilitation care pathway Ensure standardised handover between treatment settings and treatment modalities by secure within one week of final assessment Metastatic disease Palliative care Clear referral pathways for patients with palliative and specialist palliative care needs Clear referral guidance for management of: End of Life care Complex symptom control GP and palliative care team to manage patient as appropriate Patients provided with information on local hospices and charity groups Acute oncology Acute presentation at A&E Full acute oncology service with clear guidelines such as neutropaenic sepsis and metastatic spinal cord compression Use a flag warning system to identify patients who have had chemotherapy or radiotherapy within the last 6 weeks Contact details of all OG cancer centre staff to be available in A&E department Specialist Palliative Care Teams to be linked together Use a flag warning system to identify any O-G cancer patients when they present Alert the appropriate oncology team for any O-G cancer patients admitted via A&E Trials and Research Clinical Trials Take full part in all relevant clinical trials Research and innovation Ensure all patients asked at first appointment if they would consider being entered into a clinical trial. Entry into trials offered at first decision to treat appointment after histology and CT is available Carry out prospective audit of service and publish transparent outcomes data 16

17 OG CANCER CENTRE SPECIFICATION Participation in London Cancer audit programme and National Audits Education and training Patient travel Training for specialist CNS staff in specialist Upper GI cancer work Training for dietitians to become level 3 and 4 specialists Training courses for all professional members in specialist Upper GI Inform patients and relatives of support available for travel to cancer centre Assists patient in benefits application for travel costs Revise criteria for patient transport so it can be offered to a greater selection of patients who need it Adequate provision for patient transport and clear support strategies for patients relatives 17

18 Appendix 1: London Cancer OG Technical Group London Cancer Technical Group members Attendees Name Trust/Organisation Alex Tran GP Brian Hill Patient Representative Bijen Patel BH Clare Lait London Cancer Cate Simmons PAH David Khoo BHR Dalisay Domingo BHRUT Elizabeth Crisp Patient Representative Angela Wong BH Andrew Millar NMUH Dipankar Mukherjee BHRUT Majid Hashemi UCLH Muntzer Mughal UCLH Matthew Guinane HUH Emma Painter London Cancer Nathalie Osborne UCLH Frances Hughes BH Rosemary Phillips PAH Kim Ainsworth NELCN Judith Douglas London Cancer Amalesh Thangorai BHRUT Rashmi Soni BH Mike Pine BCFH Sarah Slater BH Teresa Moss UCLP Martina Kelly HUH Alison Wade BHRUT Ashish Rohatgi BH Khaled Dawas UCLH London Cancer OG Technical Group meeting dates 11 December 2012 (pre-meet of surgeons) 14 January February March March

19 Appendix 2 Patient pathway GP appointment Suspicion of cancer 2ww clinic at local unit Assessed by specialist, consultant to decide next steps Straight to test Gastroscopy (local cancer unit) Gastroscopy (local cancer unit) CT scan (local cancer unit) CT scan (local cancer unit) Local MDT discussion Any cancer discussed at SMDT Operable first O/P appointment at surgical centre Definitive chemotherapy / radiotherapy Palliative care local hospital 19